Oral Bisphosphonate Administration on a Hip Fracture Unit : Knowledge, Practice & Patient Experience Audit
Abstract
INTRODUCTION
Oral bisphosphonates are widely prescribed for fracture prevention. Their efficacy is dependent on adherence to administration guidance. A British Geriatrics Society (BGS) review highlighted that incorrect administration provides minimal or no fracture protection, particularly in frail or hospitalised patients (1,2). Despite this, oral bisphosphonates are frequently prescribed or continued during inpatient admissions where correct administration may be challenging. Our aim was to assess multidisciplinary knowledge, local administration practice, and patient recall of administration of oral bisphosphonates, to determine whether these are being given in line with ROS guidance on the acute inpatient ward.
METHOD
This audit is currently in progress, using two approaches:
1. Staff Knowledge & Practice
An anonymous questionnaire has been distributed to all clinical staff involved in prescribing, administering or overseeing medications. The questionnaire assesses:
· Knowledge of correct administration according to ROS guidance
· Awareness that incorrect administration negates effectiveness
· Self-reported local practice and perceived barriers
· Confidence and training needs
2. Patient Recall Post-Administration
Following administration of oral bisphosphonates, inpatients are being asked a set of questions including how the medication was given (timing, fluid, posture) and what instructions they recall receiving.
Patient responses will be compared with ROS administration standards to assess real-world practice.
Data will be analysed descriptively.
RESULTS
This audit is expected to:
· Identify knowledge gaps within the MDT
· Highlight discrepancies between intended practice and patient reports
· Identify barriers specific to the inpatient environment
· Inform targeted education and prescribing decisions
CONCLUSIONS
Depending on findings, proposed interventions include:
· Multidisciplinary education sessions
· A ward-based bisphosphonate administration checklist
· Greater consideration of withholding oral bisphosphonates
REFERENCES
1. British Geriatrics Society (BGS) (2019) The care of patients with fragility fracture (Blue Book).
2. Royal Osteoporosis Society (ROS) (n.d.) Alendronic acid and Risedronate: drug treatment for osteoporosis.
Comments
Treatment of Osteoporosis
Dexa scans are not the standard of care across the world. While bisphosphonates have been shown to be effective in management, it is not possible to prove the condition in low income settings. Not sure how to navigate this dilemma
Treatment of Osteoporosis
That's an important point. At the conference today there was an interesting talk on sub-Saharan Africa - mainly South Africa and Zimbabwe - discussing the difficulties in communities where DEXA scans are very limited. It is true that the evidence base for bisphosphonate efficacy is largely built on populations where osteoporosis has been confirmed radiologically, and that doesn't translate easily to settings without that diagnostic pathway. Clinical risk prediction tools like FRAX, which can be used without BMD, may offer a partial way forward in those contexts...
Osteoporosis treatment
Interesting and highly relevant audit. In our service, adherence to oral bisphosphonates remains challenging even with once-weekly dosing, and concerns regarding correct administration often lead us to consider intravenous zoledronic acid where appropriate. It will be interesting to see whether the findings support a shift towards alternative osteoporosis treatment strategies in selected older adults rather than focusing solely on improving administration practices.
Hi Anne,Indeed! Precisely…
Hi Anne,
Indeed! Precisely why this audit was important for us. We administer IV zoledronic acid for many of our patients - carefully considered in view of degree of frailty, crcl, calcium and vit D levels etc ... and whilst it could be argued that nearly all patients could go straight onto parenteral treatment, literature shows that commencing first-line with alendronic acid/risedronate is effective for appropriate patients who are compliant. IV zoledronic acid carries the a further logistical challenge of administering subsequent doses - as these have to be given as day cases in secondary care settings - which needs to be viewed as a whole in terms of cost to the service.
Osteoporosis treatment
A very interesting audit and data that will be very applicable within secondary care. Alongside the ROS guidance were prescribers aware of dose omission with reduced creatinine clearance, as from experience they're not always held?
Osteoporosis treatment
Thank you, excellent point. On our hip fracture unit we do check creatinine clearance on all patients to guide appropriate bone health treatment options prior to prescribing bisphosphonates.